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Diabetes Management In Long-term Care Setting

Diabetes Management In Long-term Care: An Exploratory Study Of The Current Practices And Processes To Managing Frail Elderly Persons With Type 2 Diabetes.

Diabetes Management In Long-term Care: An Exploratory Study Of The Current Practices And Processes To Managing Frail Elderly Persons With Type 2 Diabetes.

School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada. School of Nursing, McMaster University, Hamilton, Ontario, Canada; Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario, Canada. Electronic address: [email protected] School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Schlegel University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada. There is limited evidence for the management of diabetes in frail elderly residents living in long-term care (LTC) settings. The purpose of this study was to explore the current practices of glycemic management in frail elderly persons with diabetes living in LTC settings. Using a mixed-methods convergent parallel design, this study surveyed medical directors and attending physicians of long-term care centres through an online questionnaire and one-on-one semistructured interviews. A total of 39 questionnaires were completed, representing a variety of LTC settings, including private and public settings. Diabetes management practices varied across the participating settings with respect to glucose targets, with 69% of respondents selecting glycated hemoglobin levels of 8% or greater as being appropriate for LTC residents. Blood glucose monitoring, pharmacotherapy, presence of comorbidities, frailty and life expectancy were highlighted as variables for consideration in diabetes management in LTC. Interviews with attending physicians further illustrated the variability of opinions related to the use of clinical practice guidelines, glucose target levels and intensity of management (i.e. blood glucose monitoring and pharmacotherapy). The findings of this study were triangulated with both the quantitative s Continue reading >>

Management Of Diabetes In Longterm Care And Skilled Nursing Facilities: A Position Statement Of The American Diabetes Association

Management Of Diabetes In Longterm Care And Skilled Nursing Facilities: A Position Statement Of The American Diabetes Association

N2 - Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve dia Continue reading >>

Don’t Use Sliding Scale Insulin (ssi) For Long-term Diabetes Management For Individuals Residing In The Nursing Home.

Don’t Use Sliding Scale Insulin (ssi) For Long-term Diabetes Management For Individuals Residing In The Nursing Home.

Rationale and Comments: SSI is a reactive way of treating hyperglycemia after it has occurred rather than preventing it. Good evidence exists that SSI is neither effective in meeting the body’s insulin needs nor is it efficient in the long-term care setting. Use of SSI leads to greater patient discomfort and increased nursing time because patients’ blood glucose levels are usually monitored more frequently than may be necessary and more insulin injections may be given. With SSI regimens, patients may be at risk from prolonged periods of hyperglycemia. In addition, the risk of hypoglycemia is a significant concern because insulin may be administered without regard to meal intake. Basal insulin, or basal plus rapid-acting insulin with one or more meals (often called basal/bolus insulin therapy) most closely mimics normal physiologic insulin production and controls blood glucose more effectively. Sponsoring Organizations: American Medical Directors Association Sources: Expert consensus Disciplines: Endocrinologic Geriatric Medicine References: • Sue Kirkman M, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, Huang ES, Korytkowski MT, Munshi MN, Odegard PS, Pratley RE, Swift CS. Consensus Development Conference on Diabetes and Older Adults. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012 Dec;60(12):2342-56. • American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012 Apr;60(4):616-31. • Haq J. Insulin sliding scare, does it exist in the nursing home. JAMDA. 2010 Mar;11(3):B14. • Hirsch IB. Sliding scale insulin—time to stop sliding. JAMA. 2009;301(2):213-214. • American Medical Directors Asso Continue reading >>

Management Of Diabetes In Long-term Care And Skilled Nursing Facilities: A Position Statement Of The American Diabetes Association.

Management Of Diabetes In Long-term Care And Skilled Nursing Facilities: A Position Statement Of The American Diabetes Association.

Diabetes Care. 2016 Feb;39(2):308-18. doi: 10.2337/dc15-2512. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association. Beth Israel Deaconess Medical Center and Joslin Diabetes Center, Harvard Medical School, Boston, MA [email protected] Geriatric Research Education and Clinical Centers, Miami Veterans Affairs Healthcare System and University of Miami, Miami, FL. Section of General Internal Medicine, The University of Chicago, Chicago, IL. Johns Hopkins University School of Medicine, Baltimore, MD. American Diabetes Association, Alexandria, VA. Department of Geriatrics, Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, FL. Kadlec Regional Medical Center, Richland, WA. University of Rhode Island College of Pharmacy, Providence, RI. Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients trans Continue reading >>

New Guidance On Diabetes Care In Elderly Residential Facilities

New Guidance On Diabetes Care In Elderly Residential Facilities

New Guidance on Diabetes Care in Elderly Residential Facilities New American Diabetes Association (ADA) guidelines addressing diabetes management in long-term care and skilled nursing facilities emphasize treatment simplification, avoidance of hypoglycemia, and the need to reassess therapeutic goals for patients who are nearing the end of life. The guidelines were published in the February issue of Diabetes Care by Medha N Munshi, MD, director of the Joslin Geriatric Diabetes Program, Boston, Massachusetts, and colleagues. Previous statements from the ADA have addressed care for the elderly in community settings and diabetes care among hospitalized patients, but this is the first to specifically address the unique needs of patients in long-term care settings, where the approach to diabetes management often needs to be dramatically altered from those in younger and healthier patients, Dr Munshi told Medscape Medical News. "We've developed great protocols for looking at the numbers in managing diabetes. My fight in geriatric diabetes is we need to look at what the patient needs," she said. The guidelines are aimed at a variety of audiences. For endocrinologists and primary-care clinicians with expertise in diabetes, they provide additional information about the special considerations in institutionalized elderly patients. This includes guidance on the assessment of functional capacity and common comorbidities that may interfere with diabetes care and strategies for simplifying treatment regimens the opposite of the usual practice of adding more medications. "As a geriatrician, I see a lot of inappropriate care and things done to patients at the end of life, not because people aren't trying to help or aren't paying attention, but simply because they don't know what to do. Continue reading >>

Amda – The Society For Post-acute And Long-term Care Medicine

Amda – The Society For Post-acute And Long-term Care Medicine

Don’t use sliding scale insulin (SSI) for long-term diabetes management for individuals residing in the nursing home. SSI is a reactive way of treating hyperglycemia after it has occurred rather than preventing it. Good evidence exists that SSI is neither effective in meeting the body’s physiologic insulin needs nor is it efficient in the long-term care (LTC) setting in medically stable individuals. Use of SSI is associated with more frequent glucose checks and insulin injections, leads to greater patient discomfort and increased nursing time and resources. With SSI regiments, patients may be at risk from wide glucose fluctuations or hypoglycemia when insulin is given when food intake is erratic. These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician. Continue reading >>

Diabetes Care In Institutional Settings & Your Rights

Diabetes Care In Institutional Settings & Your Rights

Diabetes & You > Know Your Rights > Diabetes Care in Institutional Settings & Your Rights Diabetes Care in Institutional Settings & Your Rights What is Diabetes Canadas position on diabetes care in institutional settings? People with diabetes should receive care that promotes the highest quality of life regardless of the setting. People with diabetes have a right to timely, affordable and ongoing diabetes education and comprehensive treatment services provided with seamless coordination by a Diabetes Health-care Team and other specialists as specified in Diabetes Canadas Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada and Standards for Diabetes Education in Canada. Readthe Diabetes Canada's full position statement on diabetes care in institutional settings , including background and rationale. What kind of diabetes care should a resident expect? A resident living with diabetes in a nursing home/long term care facility, group home, hospital or correctional facility requires the same care recommended to other Canadians living with diabetes as specified in Diabetes Canadas Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada . Are there guidelines available to assist institutions with developing diabetes care plans for their residents? Diabetes Canadas Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada provides comprehensive, evidenced-based recommendations for health-care professionals and anyone caring for people with diabetes. Guidelines address issues applicable to caring for individuals living with diabetes in institutional settings: Continue reading >>

Shorrock Gardens Care Center | Long-term Care

Shorrock Gardens Care Center | Long-term Care

Long-term care is when a person requires assistance with his or her physical or emotional needs over an extended period of time. The need might be due to a chronic condition, disability, illness, injury or simply from the challenges of getting older. The need for long-term care may only last for a few weeks or months, or it may extend for years as is customary in a traditional nursing home. We provide the services and supplies that your family member needs while he or she is a resident at our center. This help may be required for many of the activities or needs of daily living, including: Our Bariatric services are designed to promote and maintain the residents quality of life. Using a multi-disciplinary approach, dedicated professionals educated in the treatment of bariatric care work with the resident, their family, and their facility and for the residents residential setting. Our Bariatric residents may receive services such as: Specialized equipment, utilizing Bariatric-specific guidelines In the long-term setting we provide cardiac care to help patients enjoy a quality of life, despite having conditions such as congestive heart failure, high blood pressure or any other number of cardiac ailments. Our goal is to help each patient achieve positive outcomes, maintain or improve their level of functioning, and participate in the numerous activities offered throughout the day at Shorrock Gardens Care Center. Individualized plans of care are developed to meet each patients specific needs. Diabetes is a common, chronic disease that affects more than 23 million people in the United States alone, according to the American Diabetes Association. Successful management of the disease requires changes in lifestyle, diet and personal care. Our staff is experienced in assisting w Continue reading >>

Management Of Diabetes In Long-term Care And Skilled Nursing Facilities: A Position Statement Of The American Diabetes Association

Management Of Diabetes In Long-term Care And Skilled Nursing Facilities: A Position Statement Of The American Diabetes Association

Published online 2016 Jan 11. doi: 10.2337/dc15-2512 Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association 1Beth Israel Deaconess Medical Center and Joslin Diabetes Center, Harvard Medical School, Boston, MA 2Geriatric Research Education and Clinical Centers, Miami Veterans Affairs Healthcare System and University of Miami, Miami, FL 3Section of General Internal Medicine, The University of Chicago, Chicago, IL 4Johns Hopkins University School of Medicine, Baltimore, MD 5American Diabetes Association, Alexandria, VA 6Department of Geriatrics, Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, FL 7Kadlec Regional Medical Center, Richland, WA 8University of Rhode Island College of Pharmacy, Providence, RI Copyright 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. This article has been cited by other articles in PMC. Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tail Continue reading >>

Managing Diabetes In Long-term Care Facilities

Managing Diabetes In Long-term Care Facilities

Managing Diabetes in Long-Term Care Facilities Allan S. Brett, MD reviewing Munshi MN et al. Diabetes Care 2016 Feb . An American Diabetes Association position statement reviews the goals and strategies of treatment in such facilities. In 2012, the American Diabetes Association (ADA) first published a position statement advocating a patient-centered approach for treatment of type 2 diabetes ( NEJM JW Gen Med Aug 15 2012 and Diabetes Care 2012; 35:1364). Among other things, the statement recognized that stringent glycemic control was not appropriate for patients with limited life expectancies, extensive comorbidities, and high risk for hypoglycemia. These characteristics apply to many people in long-term care (LTC) and skilled nursing facilities, and now the ADA has issued a position statement on managing diabetes in such facilities. Intensive glycemic control is of limited benefit in this population. Avoiding hypoglycemia is paramount; patients in LTC facilities are at high risk for hypoglycemia, and their ability to recognize its symptoms often is limited. However, severe hyperglycemia also has adverse effects including dehydration, electrolyte abnormalities, and the hyperosmolar syndrome in LTC patients. Sliding scale insulin generally should be avoided; simplified treatment regimens are preferred. In LTC facilities, blood glucose and glycosylated hemoglobin measurements should be performed as necessary to lower risk for hypoglycemia and severe hyperglycemia but not to achieve tight glycemic control. Restrictive diabetic diets often are counterproductive in this setting; patients' personal food preferences should be respected. This ADA statement reminds us that many of the principles of diabetes treatment for community-dwelling adults don't necessarily apply to patie Continue reading >>

Diabetes In Long-term-care And Skilled Nursing Facilities: The Ada Position Statement

Diabetes In Long-term-care And Skilled Nursing Facilities: The Ada Position Statement

US Pharm. 2016;41(10)(Diabetes suppl):7-11. ABSTRACT: As the number of elderly people in the United States continues to rise, an increasing proportion of older adults will develop diabetes and will need long-term or skilled care. In early 2016, the American Diabetes Association issued a position statement on the management of diabetes in long-term-care and skilled nursing facilities. This statement provides recommendations for the general approach to care; goals and strategies for glycemic control; diabetes management during transitions of care and end of life; and suggestions for integration of diabetes management into long-term-care facilities. Pharmacists can play an active role in each of these areas in order to help optimize glycemic control in their patients. The prevalence of diabetes in the long-term-care (LTC) setting is estimated to range from 25% to 34%,1 which is equal to or higher than trends seen in the general population. The latest National Diabetes Statistics Report (2014) estimates that, in the United States, 25.9% of persons aged ≥65 years have diabetes, compared with 16.2% of those aged 45 to 64 years and 4.1% of those aged 20 to 44 years.2 Among persons aged 65 to 74 years and those aged ≥75 years, there was an increase of 113% and 140%, respectively, in the rate of diagnosed cases of diabetes from 1993 to 2014.3 Diabetes is the seventh leading cause of death in the U.S.2 As baby boomers continue to age, the proportion of older adults with diabetes who will need nursing homes (NHs) or skilled care is expected to rise. Pharmacists who serve residents in the LTC environment must be prepared to meet this challenge. Type 2 diabetes (T2D) accounts for 90% to 95% of diabetes in the U.S. Age-related changes in older adults that predispose them to the T Continue reading >>

Diabetes Management In Long-term Settings

Diabetes Management In Long-term Settings

Diabetes Management in Long-Term Settings A Clinician's Guide to Optimal Care for the Elderly And Sandra Drozdz Burke, PhD, ANP-BC, CDE, FAADE Study Guide by Kathleen Stanley, CDE, RD, LD/N, MSEd, BC-ADM Book, 265 pgs, and Study Guide with 1 Reporting Form, 26 pgs. Apractical and comprehensive CPE program that outlines thelatest evidence and guidelinesfor geriatric diabetes carewhich will enable you to develop effective programs to care for this growing population. For more information and customer comments, click here. For RDs/RDNs & DTRs/NDTRs for the Professional Development Portfolio 3000, 3020, 3090, 4000, 4040, 4060,4190, 5000, 5040, 5100,5160, 5190, 5460 6.3.11, 8.1.1, 8.1.2, 8.1.4, 8.1.5, 8.2.1, 8.2.4, 8.3.1, 8.3.6, 10.1.1, 10.1.2, 10.1.3, 10.2.1, 10.2.2, 10.2.4, 10.2.7, 10.2.9, 10.2.10, 12.2.1, 12.4.6 DON'T SEE your Performance Indicators or Code Listed here? There are many Performance Indicators (PIs) that are applicable we can't list them all & Per CDR you may use ANY PI or CODE as long as it relates to your Learning Plan. Share with a friend and Save! Click here for important information about sharing. To order an ADDITIONAL Reporting Form click below: Diabetes Management in Long-Term Settings A Clinician's Guide to Optimal Care for the Elderly And Sandra Drozdz Burke, PhD, ANP-BC, CDE, FAADE Study Guide by Kathleen Stanley, CDE, RD, LD/N, MSEd, BC-ADM 2017 Wolf Rinke Associates, Inc. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, without the prior written permission of the Publisher. Joyce Matera: "The course was very well written and very detailed and informative. I gained valuable knowledge about about Insulin Continue reading >>

New Ada Guidelines For Diabetes Management In Long-term Care Facilities

New Ada Guidelines For Diabetes Management In Long-term Care Facilities

New ADA Guidelines for Diabetes Management in Long-Term Care Facilities New guidelines from the American Diabetes Association (ADA) address diabetes management in long-term care and skilled nursing facilities, emphasizing treatment simplification, avoidance of hypoglycemia, and reassessment of therapeutic goals for patients who are nearing the end of life. The guidelines were published in the February issue of Diabetes Care. Previous statements from the ADA have addressed diabetes care for the elderly in community settings and among hospitalized patients, but this is the first set of guidelines to specifically address the unique needs of patients in long-term care settings, where the approach to diabetes management often needs to be dramatically different from those for younger and healthier patients. The guidelines, authored by Medha N Munshi, MD, director of the Joslin Geriatric Diabetes Program, Boston, MA, and colleagues, are aimed at a variety of audiences. For endocrinologists and primary care clinicians with expertise in diabetes, they provide additional information about the special considerations in institutionalized older adults. This includes guidance on the assessment of functional capacity and common comorbidities that may interfere with diabetes care as well as strategies for simplifying treatment regimensthe opposite of the usual practice of adding more medications. For nursing home directors, nurses, clinical pharmacologists, and others who work in centers with older patient populations, the document provides detailed diabetes-specific information and guidance, including minimization of hypoglycemia and a medication roundup. Increasing evidence points to the risks of hypoglycemia in older adults. Even less severe hypoglycemia can be catastrophic in olde Continue reading >>

Part 3: Managing Diabetes In Long-term Care: Alternatives To Sliding Scale

Part 3: Managing Diabetes In Long-term Care: Alternatives To Sliding Scale

Part 3: Managing Diabetes in Long-term Care: Alternatives to Sliding Scale This program focuses on the hazards of the sliding scale and provides a recommended treatment approach for patients in the long-term care setting. President, Network Geriatric Services. Assistant Professor Edward Via College of Osteopathic Medicine Zhang X, Decker FH, Luo H, et al. Trends in the prevalence and comorbidities of diabetes mellitus in nursing home residents in the United States: 1995-2004. J Am Geriatr Soc. 2010;58(4):724-730. Dybicz SB, Thompson S, Molotsky S, Stuart B. Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents. Am J Geriatr Pharmacother. 2011;9(4):212-223. American Medical Directors Association. Diabetes Management in the Long-Term Care Setting: Clinical Practice Guideline. Columbia, MD: American Medical Directors Association; 2010. Resnick HE, Heineman J, Stone R, Shorr RI. Diabetes in U.S. nursing homes, 2004. Diabetes Care. 2008;31(2):287-288. Inzucchi SE, Bergenstal RM, Buse JB, et al; American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35(6):1364-1379. Handelsman Y, Mechanick JI, Blonde L, et al; AACE Task Force for Developing Diabetes Comprehensive Care Plan. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract. 2011;17(suppl 2):1-53. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria f Continue reading >>

Implementation Of A Diabetes Management Flow Sheet In A Long-term Care Setting - Sciencedirect

Implementation Of A Diabetes Management Flow Sheet In A Long-term Care Setting - Sciencedirect

Implementation of a Diabetes Management Flow Sheet in a Long-Term Care Setting Physicians lack clear guidance about adaptation of clinical practice guidelines for elderly institutionalized patients with diabetes. In a large long-term care facility, a diabetes management flow sheet was trialed to determine which clinical parameters were found useful by clinicians in the management of diabetes in that setting. Clinical practice guidelines for diabetes management were reviewed with attending physicians. Diabetes management flow sheets were distributed for all patients coded as having diabetes on their most recent minimum data sets. After a period of 14months, flow sheet completion rates were ascertained and physicians were surveyed regarding the utility of the flow sheet. Initial flow sheet data were completed in full or in part for only 57% of the 121 study subjects; 39% of the subjects died within 14months. Quarterly follow-up data were completed for 58% of the flow sheets. The diabetes management flow sheet was not found to be useful by attending physicians as a chronic-disease management tool. Les mdecins manquent dorientation claire concernant ladaptation des lignes directrices de pratique clinique pour le suivi des patients gs hbergs souffrant de diabte. Dans un tablissement de soins de longue dure, une feuille de suivi du diabte a t mise lessai par les cliniciens concerns par la prise en charge du diabte dans ce milieu pour dterminer quels paramtres cliniques se sont avrs utiles. Les mdecins traitants ont pass en revue les lignes directrices de pratique clinique en matire de prise en charge du diabte. Les feuilles de suivi du diabte ont t distribues tous les patients classifis diabtiques selon les donnes les plus rcentes du fichier minimal. Aprs une priode de 14 mo Continue reading >>

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